Does pred always lose effectiveness over time?

I've heard anecdotal evidence on this forum of prednisone losing effectiveness the more times you use it. Is this true for everyone? I never had to take it until 2013, but the first several times I took it, it made me feel perfect within just 2-3 days and 100% normal for the first time since pre-UC. I always started at 40 mg. Last summer, when I flared up really bad after starting smoking again, 40 mg did not help and I had to go up to 50 mg. I just started on 40 again last Friday and it's not helping. I went up to 50 yesterday and I'm still bleeding. I'm just wondering if it always loses effectiveness, and if so, I guess that means eventually I will probably just need surgery when it stops working? I hate this disease!!!!!

I just left a rambling 4-minute voicemail for my doctor's office basically begging for pain pills. I am so sick of being treated like a drug seeker and never getting pain meds unless I am hospitalized or go to the ER. I am only wanting them once or twice a year for flares and just enough for a few days so I can sleep and halfway function! I don't think that is too much to ask for. I shouldn't have to go to the ER, waste half a day, pay a ton of money, have them do stupid tests even though I know what's wrong with me, just to get a whopping 10 pain pills like they gave me last June when my GI could just give me a script.

I quit smoking yesterday. If I don't get into remission and stay in remission this time, I'll try Remicade, or Inflectra, since my insurance said it preferred it...

I had most severe disease when I first got diagnosed though and 5 asas got me into remission the first 6 years. I dont have nearly as severe symptoms now and pred doesnt work as well. My scopes arent as bad either in terms of disease severity.

When I upped my dose to 50 mg, I was better after about 2-3 days. Maybe my body will just always need 50 mg from now on...guess I'll find out! Thanks for the feedback, Levi.

I hear what you're saying, but if you read what I first replied to you -- my inflammation was way more severe and way more widespread (entire colon) when first diagnosed, and I didn't even need pred back then for the first 6ish years I had UC. And it has been more severe other times in the past 7 years and 40 mg was sufficient. So that's why I don't believe that is what is going on with me personally.

I don't think prednisone loses its effectiveness. I think what happens to some people is their disease changes and pred stops working. I've had to take pred 6 or 7 times since I was diagnosed in 2003, and it kicks butt every time without fail.
That being said, Pred doesn't work as a maintenance med, and if you take it for too long it will lose its effectiveness.

Interesting point poopydoop. I've been on 3 rounds of prednisone, and I did notice it being less effective each time. Spread of inflammation didn't appear to be worst on colonoscopy. Perhaps it does have to do with the immune response and how it changed over time. I also notice side effects worsen each time - first time: no side effects, just more energy which I actually kind of enjoyed. 3rd time: acne, hair falling out, terrible moon face, ragey stress. Part of me also wondered if it had to do with age, my body not being able to handle a drug like prednisone and bounce back like it did in my 20s.

I mean that it's only meaningful to compare the current state of inflammation with how it was in the beginning if you would come off all the medication that you use to treat the colitis (assuming in the beginning you started at zero colitis medication). If a drug becomes less effective it does not necessarily mean that it doesnt "work" any more but it could mean (for example) the immune system is even more overactive than before so requires stronger immunosuppression or anti inflammatories to calm it down

I wasn't ever on pred for the first 6 years I had UC though. I was on 5-ASAs only. Then the first handful of times I took pred, it worked great at 40 mg and I don't think my symptoms or scopes are any worse now than they were then, if that makes sense. I guess we are all different. iPoop -- I always considered pred a wonder drug for me in the past. Anyway, thanks for the feedback. Interesting to hear others' experiences. I read something the other day about how when we have chronic pain, our nerves change and we can't handle pain as well as we used to, even if the actual inflammation/damage isn't as bad. I found that interesting.

MariaMaria said...
Interesting point poopydoop. I've been on 3 rounds of prednisone, and I did notice it being less effective each time. Spread of inflammation didn't appear to be worst on colonoscopy. Perhaps it does have to do with the immune response and how it changed over time. I also notice side effects worsen each time - first time: no side effects, just more energy which I actually kind of enjoyed. 3rd time: acne, hair falling out, terrible moon face, ragey stress. Part of me also wondered if it had to do with age, my body not being able to handle a drug like prednisone and bounce back like it did in my 20s.

Yeah, maybe age has something to do with it as well, and just my overall health. I used to take better care of myself, exercise more, eat better, etc. Maybe it's only not working as well for me now because I started smoking, too. I didn't smoke any of those other times...

Will do! I always do ask them a ton of questions! Lol. I like him already just having spoken to him over the phone, and because he actually gave me some pain medication! I have historically had a really hard time with doctors ever giving me pain meds despite me being in severe pain. I haven't had to take it yet but just having some on hand and knowing I have it if I am serious unbearable pain gives me peace of mind. He's running stool tests for c diff and calprotectin (sp?) too so he's doing the right thing (the first GI at that office who I spoke to last week just gave me pred and at a really fast taper and his nurse was super rude to me and incompetent...).

Glad your initial impression was good of the new doc. You've likely got a good one, if your gut-feeling says so.

Wait and see how the taper goes, at least you have a few options to ponder in the mean time.

Congrats on you quitting smoking....and it's awecome that you like your new GI!! A HUGE factor.

Lots of future possible treatments to consider....hope this pred taper process goes smoothly for you.
Hugs,
q

In answer to your question. I would say, without a doubt, YES. Pred does get less effective over time.

And believe me, I would know more than most on this forum. Aint nobody who has had more experience with Pred than me around here. And that is not a boast.

I have been on Pred for most of the last 20 years.

My first flares, 40mg - my symptoms disappeared in days. Years later. I had to to up to 50mg. Fast forward 10 years, I had to start at 60mg to see ANY difference. And my last flare in 2016, I had to take 80 mg of Pred for it to even touch my flare. So, there you have it. Make of that what you will.

Of course all drug are different. But, our bodies build up tolerance to ANY drug. Be that Pred, diazepam or Heroin. A drug is a drug. And your body WILL eventually need more for the same effect. Ask any drug addict.

I am now at a stage where Pred hardly works anymore. Thank god I am in remission on a trial drug. As steroids are no longer the saviour they once were.